Home / Opinion / Commentary / Backed by state Constitution, Medicaid expansion makes sense

Backed by state Constitution, Medicaid expansion makes sense

John Fisher (Submitted photo)

John Fisher (Submitted photo)

In this weekend’s Medicaid coverage, the governor made the point that her decision to move forward with Medicaid expansion was a combination of common sense and gut. She knew when making this tough call that the math did not work in Arizona’s favor to try to go it alone on funding a program that has, for decades, been a mix of state and federal funds.

Depending on the approach, refusing to expand would leave us with less or none of the federal funds we’ve historically used. In the end, the question for her was: do we only use state funds, leaving the general fund overextended and vulnerable, or do we continue to use the opportunity to have a mix of dollars that gives us a stable fiscal environment, enough money to fund the state’s responsibilities without fear of imminent tax increases or dramatic cuts to programs, and have the ability to meet parent and business demands for strategic investment — particularly in education? Doesn’t seem like much a choice, does it? And that’s why the governor’s plan makes sense.

The Arizona Constitution requires the governor to suggest a budget that meets the mandate to balance obligations with revenue. The Constitution doesn’t allow her to ignore voter instructions to ensure that our health care system doesn’t collapse under the weight of uncompensated care and it doesn’t let her ignore the needs of the K-12 and higher education systems she and the Arizona Legislature have been mandated since statehood to maintain. Our state Constitution currently reads that the Legislature shall make such appropriations as to “… insure the proper maintenance of all state educational institutions, and shall make such special appropriations as shall provide for their development and improvement.”

Though the recession and other economic activity impact the options available to the Legislature and the governor, governance decisions also control the viability of the state coffers — most directly with their budgeting decisions. For those in the Legislature who would use nearly a billion dollars a year, and growing, of state-only funds and put hundreds of millions of dollars to education funding in jeopardy, we strongly suggest they pay attention to the pragmatic and responsible approach suggested by Governor Brewer.

In the coming years, health care, Medicaid and education funding scenarios will shift as presidents come and go and elected officials rotate through the turnstile. But using the best information we have today, the members of Stand for Children strongly support mixing state and federal funds to ensure our state dollars go as far as possible, remain stable, and allow for responsible maintenance of our all-important educational system.

Whether our children attend public district schools, public charter schools or one of our many community colleges or universities, overburdened state budgets hurt how we deliver services, the consistency of those services over the course of many years, and the ability of the Legislature to be thoughtful and analytical about whether those education policies are working.

Those who try to isolate Medicaid as a federal issue are giving short shrift to the expectations of the statewide constituencies of the Legislature, our expectations for their state representation and the direction of state’s founding documents. There are many realities about life that we often don’t like. Liking or not liking the politics of our nation’s capital should not be the emotion-driven deciding factor for how to run our state.

— John Fisher is executive director of Stand for Children Arizona


  1. John,

    Your article makes a world of sense and is by far the best editorial I’ve seen on the need to expeditiously pass the Governor’s Medicaid Expansion proposal. You powerfully drive home the point that our schools and other vital public services will suffer if Medicaid expansion fails to pass, and large numbers of needy Arizonans will be cold-heartedly denied health care coverage.

    Why do so many of our legislators – including Rep Paul Boyer and Rep John Kavanaugh, and former Senators Antenori and Gould – insist on attempting to derail the Governor’s sound proposal due to their ideological opposition to the federal Affordable Care Act?

    It is indeed fortuitous that former Rep. Matt Heinz, MD (D-Tucson) has accepted a federal appointment as Director of Provider Outreach to assist in full implementation of the Affordable Care Act (ACA). I strongly urge both current and former legislators who have problems with the ACA to contact former Representative Dr. Matt Heinz. I am sure that he will give serious consideration to any constructive proposals to improve the Affordable Care Act’s ability to serve our nation’s citizens, together with doctors, hospitals and other health care providers.


    John Newport, PhD, DrPH (Doctor of Public Health)
    Former Senior Health Services Policy Analyst, UCLA School of Public Health
    Tucson, AZ

  2. Well stated. It will take a chorus of stakeholders to regain our momentum in AZ.

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